EOB Codes and Descriptions - Kymmis.com

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KYEOB257KENTUCKY EOB/ESC CROSSWALK TO HIPAAMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESHIPAA ADJ RSN CODEDESCRIPTIONHIPAAREMARKHIPAA REMARK CODEDESCRIPTIONMEDICAID DESCRIPTIONOUR RECORDS INDICATE THAT THERECIPIENT WAS OVER 21 YRS OLD ON THEDATE(S) OF SERVICE. THE RECIPIENT ISNOT ELIGIBLE FOR THE SERVICE(S). 257 96 Non-covered charge(s). N30 Recipient ineligible for this service.258 MEDICARE SUSPECT/DENTAL. 258 22259THE RECIPIENT HAS MEDICARE PART B.PLEASE BILL MEDICARE. 259 226109The procedure/revenue code isinconsistent with the patient's age.Payment adjusted because thiscare may be covered by anotherpayer per coordination of benefits.Payment adjusted because thiscare may be covered by anotherpayer per coordination of benefits.Claim not covered by thispayer/contractor. You must sendthe claim to the correctpayer/contractor.MA64MA64MA04MA83Our records indicate that we shouldbe the third payer for this claim. Wecannot process this claim until wehave received payment informationfrom the primary and secondarypayers.Our records indicate that we shouldbe the third payer for this claim. Wecannot process this claim until wehave received payment informationfrom the primary and secondarypayers.Secondary payment cannot beconsidered without the identity of orpayment information from theprimary payer. The information waseither not reported or was illegible.Did not indicate whether we are theprimary or secondary payer. Refer toItem 11 in the HCFA-1500instructions for assistance.260261CLAIM DENIED. THE KENTUCKY MEDICALASSISTANCE PROGRAM IS ONLYRESPONSIBLE FOR BUY-IN PREMIUMS FORTHIS RECIPIENT. MEDICAID CLAIMS ARE NOTREIMBURSABLE FOR THIS RECIPIENT. 260 96 Non-covered charge(s). N192OUR RECORDS INDICATE THAT THERECIPIENT WAS DECEASED PRIOR TO THEENDING DATE OF SERVICE. 261 13RECIPIENT IS NOT ELIGIBLE ON THE DATEThe date of death precedes thedate of service.Patient is a Medicaid/QualifiedMedicare Beneficiary.262 OF SERVICE. 259, 262 A1 Claim denied charges. N30 Recipient ineligible for this service.Expenses incurred prior to26 coverage.Expenses incurred after coverage27 terminated.CLAIM DENIED. RECIPIENT NOT ELIGIBLE263 FOR PORTION OF DATES OF SERVICE. 263 A1 Claim denied charges. N30 Recipient ineligible for this service.Expenses incurred prior to26 coverage.Expenses incurred after coverage27 terminated.Claim denied as patient cannot beMissing/incomplete/invalid patient264 RECIPIENT NAME IS MISSING. 264 31 identified as our insured.MA36 name.INCORRECT RECIPIENT IDENTIFICATIONClaim denied as patient cannot be265 NUMBER. 265 31 identified as our insured.RECIPIENT NOT ELIGIBLE FOR WAIVER266 SERVICES. 266 96 Non-covered charge(s). N30 Recipient ineligible for this service.267WAIVER PAYMENT AMOUNT REDUCED DUETO RECIPIENT CONTINUING INCOME 267 142Claim adjusted by the monthlyMedicaid patient liability amount.268269270RECIPIENT MAID NUMBER ON CLAIM DOESNOT MATCH THE RECIPIENT MAID NUMBERON ATTACHED ELIGIBILITY CARD. 248, 249, 259, 262, 263, 265 140CLAIM DENIED. TARGETED CASEMANAGEMENT SERVICES ARE NOTPAYABLE TO RECIPIENTS ENROLLED IN AWAIVER OR HOSPICE PROGRAM. 269 B9Patient/insured healthidentification number and namedo not match.96 Non-covered charge(s). MA61Missing/incomplete/invalid socialsecurity number or health insuranceclaim number.Services not covered because thepatient is enrolled in a Hospice. N30 Recipient ineligible for this service.CLAIM DENIED. THIS SERVICE IS NOTPAYABLE FOR A MODEL WAIVER RECIPIENT. 270 96 Non-covered charge(s). N30 Recipient ineligible for this service.271CLAIM DENIED. RECIPIENT AVAILABLEINCOME INFORMATION NOT ON FILE FORTHE MONTH OF SERVICE. PLEASECONTACT DMS AT 502-564-6885. 271 16Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.N58Missing/incomplete/invalid patientliability amount.Page 14 of 46 Date: 3/30/2005
KYEOB273KENTUCKY EOB/ESC CROSSWALK TO HIPAAMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESHIPAA ADJ RSN CODEDESCRIPTIONHIPAAREMARKMEDICAID DESCRIPTIONCLAIM/DETAIL DENIED. PROCEDURE CODE01351 IS LIMITED TO CERTAIN TOOTHNUMBERS. 273 A1 Claim denied charges. N39HIPAA REMARK CODEDESCRIPTIONProcedure code is not compatiblewith tooth number/letter274RECIPIENT TREATMENT AUTHORIZATIONINFORMATION NOT FOUND ON INPATIENTHOSPITAL FILE. 274 1562Payment adjusted because thesubmitted authorization number ismissing, invalid, or does not applyto the billed services or provider.Payment denied/reduced forabsence of, or exceeded, precertification/authorization.M62Missing/incomplete/invalid treatmentauthorization code.275INPATIENT HOSPITAL TREATMENTAUTHORIZATION NUMBER MISSING ORINVALID. 113, 274 1562Payment adjusted because thesubmitted authorization number ismissing, invalid, or does not applyto the billed services or provider.Payment denied/reduced forabsence of, or exceeded, precertification/authorization.M62Missing/incomplete/invalid treatmentauthorization code.276DETAIL DENIED. THIS SERVICE NOTPAYABLE FOR EMPOWER NON-EMERGENCYTRANSPORTATION RECIPIENTS. 276 96 Non-covered charge(s). N30 Recipient ineligible for this service.277278THE ATTACHED THIRD PARTYDOCUMENTATION IS NOT SUFFICIENT.CONTACT UNISYS PROVIDER RELATIONSFOR ASSISTANCE. 277, 279, 280, 281, 377, 467 16CLAIM DENIED. CLAIM/DOCUMENTATIONINDICATES THIRD PARTY PAYMENT WASRECEIVED BY RECIPIENT. 279, 280, 281, 282, 283, 467 100Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.Payment made topatient/insured/responsible party.N225MA92MA92Incomplete/invaliddocumentation/orders/ notes/summary/ report/ invoice.Missing/incomplete/invalid primaryinsurance information.Missing/incomplete/invalid primaryinsurance information.279280281282CLAIM/DETAIL INDICATES RECIPIENT HASOTHER INSURANCE BUT NO INSURANCEAMOUNT ENTERED ON CLAIM. 279 22A1CLAIM DENIED. YOUR CLAIM INDICATES THISSERVICE IS DUE TO A WORK-RELATEDACCIDENT/INJURY. PLEASE BILL OTHERINSURANCE FIRST. 280 19Payment adjusted because thiscare may be covered by anotherpayer per coordination of benefits.Claim denied charges.Claim denied because this is awork-related injury/illness andthus the liability of the Worker'sCompensation Carrier.RECIPIENT HAS OTHER MEDICALCOVERAGE. BILL OTHER INSURANCE FIRSTOR ATTACH DOCUMENTATION OF DENIALFROM THE INSURANCE CARRIER. 281, 465 A1 Claim denied charges. MA64THE RECIPIENT HAS MEDICARE PART A.PLEASE BILL MEDICARE. 282 109Claim not covered by thispayer/contractor. You must sendthe claim to the correctpayer/contractor.MA92MA64MA04MA83MA04MA83MA64MA04Missing/incomplete/invalid primaryinsurance information.Our records indicate that we shouldbe the third payer for this claim. Wecannot process this claim until wehave received payment informationfrom the primary and secondarypayers.Secondary payment cannot beconsidered without the identity of orpayment information from theprimary payer. The information waseither not reported or was illegible.Did not indicate whether we are theprimary or secondary payer. Refer toItem 11 in the HCFA-1500instructions for assistance.Our records indicate that we shouldbe the third payer for this claim. Wecannot process this claim until wehave received payment informationfrom the primary and secondarypayers.Secondary payment cannot beconsidered without the identity of orpayment information from theprimary payer. The information waseither not reported or was illegible.Did not indicate whether we are theprimary or secondary payer. Refer toItem 11 in the HCFA-1500instructions for assistance.Our records indicate that we shouldbe the third payer for this claim. Wecannot process this claim until wehave received payment informationfrom the primary and secondarypayers.Secondary payment cannot beconsidered without the identity of orpayment information from theprimary payer. The information waseither not reported or was illegible.Page 15 of 46 Date: 3/30/2005
Page 1 and 2: KYEOB001002003004KENTUCKY EOB/ESC C
Page 3 and 4: KENTUCKY EOB/ESC CROSSWALK TO HIPAA
Page 5 and 6: KYEOB079080081082083084KENTUCKY EOB
Page 7 and 8: KYEOB114115116117118119KENTUCKY EOB
Page 11 and 12: KYEOB200201202203KENTUCKY EOB/ESC C
Page 13: KENTUCKY EOB/ESC CROSSWALK TO HIPAA
Page 19 and 20: KYEOB343344345MEDICAID DESCRIPTIONK
Page 21 and 22: KYEOB382KENTUCKY EOB/ESC CROSSWALK
Page 23 and 24: KYEOBKENTUCKY EOB/ESC CROSSWALK TO
Page 25 and 26: KYEOB482483MEDICAID DESCRIPTIONKENT
Page 29 and 30: KYEOB555556MEDICAID DESCRIPTIONKENT
Page 31 and 32: KYEOBMEDICAID DESCRIPTIONKENTUCKY E
Page 37 and 38: KYEOB741742743744745746747748749KEN

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